The effects of gender on clinical and neurological outcomes after acute cervical spinal cord injury

The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury

BACKGROUND AND PURPOSE

How early spinal cord injury (SCI) lesions evolve in patients after injury is unknown. The purpose of this study was to characterize the early evolution of spinal cord edema and hemorrhage on MR imaging after acute traumatic SCI.

MATERIALS AND METHODS

We performed a retrospective analysis of 48 patients with clinically complete cervical spine injury. Inclusion criteria were the clear documentation of the time of injury and MR imaging before surgical intervention within 72 hours of injury. The length of intramedullary spinal cord edema and hemorrhage was assessed. The correlation between time to imaging and lesion size was determined by multiple regression analysis. Short-interval follow-up MR imaging was also available for a few patients (n = 5), which allowed the direct visualization of changes in spinal cord edema.

RESULTS

MR imaging demonstrated cord edema in 100% of patients and cord hemorrhage in 67% of patients. The mean longitudinal length of cord edema was 10.3 +/- 4.0 U, and the mean length of cord hemorrhage was 2.6 +/- 2.0 U. Increased time to MR imaging correlated to increased spinal cord edema length (P = .002), even after accounting for the influence of other variables. A difference in time to MR imaging of 1.2 days corresponded to an average increase in cord edema by 1 full vertebral level. Hemorrhage length was not affected by time to imaging (P = .825). A temporal increase in the length of spinal cord edema was confirmed in patients with short-interval follow-up MR imaging (P = .003).

CONCLUSION

Spinal cord edema increases significantly during the early time period after injury, whereas intramedullary hemorrhage is comparatively static.

Gender differences in spinal cord injury are not estrogen-dependent

Recent attention has been given to gender differences in neurotrauma, and the anecdotal suggestion is that females have better outcomes than males, suggesting that circulating levels of estrogen (E(2)) may be neuroprotective. In order to address this issue, both young adult male and ovariectomized female rats were subjected to a T10 spinal cord injury (SCI), and E2 levels were maintained at chronic, constant circulating levels. Animals were clinically evaluated for locomotor changes using the Basso-Beattie-Bresnahan (BBB) scoring system. Morphologic differences were evaluated with unbiased stereology. Data analysis failed to reveal any significant benefit for the E2 therapy in either males or females. We did find a non-estrogen-dependent difference between male and female rats in length of injury, and percent of spared tissue, with female outcomes more favorable. These results suggest that E(2) does not provide a viable therapy following SCI.

Spinal cord injury influences psychogenic as well as physical components of female sexual ability

STUDY DESIGN

Secure, web-based survey.

OBJECTIVES

Elicit specific information about sexual function from women with spinal cord injuries (SCI).

SETTING

World-wide web.

METHODS

Individuals 18 years or older living with SCI obtained a pass code to enter a secure website and then answered survey questions.

RESULTS

Bladder and/or bowel incontinence during sexual activity and/or sexual intercourse were significant concerns and prevented some women from seeking sexual activity. Autonomic dysreflexia (AD) during sexual activity was interpreted negatively by many and was found to interfere with sexual activity. Most subjects reported difficulty becoming psychologically aroused as well as physically aroused, which were both correlated with feeling that their SCI had altered their sexual sense of self. An inverse relationship existed between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. The most commonly reported sexual stimulation leading to the best arousal involved stimulation of the head/neck and torso areas. The majority of subjects reported having experienced intercourse postinjury. Most participants reported difficulty with positioning during foreplay and intercourse, vaginal lubrication, and spasticity during intercourse. Almost half reported experiencing orgasm postinjury and this was positively associated with the presence of genital sensation.

CONCLUSION

SCI significantly impairs psychological and physical aspects of female sexual arousal. In addition, bladder and bowel incontinence as well as AD negatively impact sexual activity and intercourse.

17beta-estradiol is protective in spinal cord injury in post- and pre-menopausal rats

The neuroprotective effects of 17 beta -estradiol have been shown in models of central nervous system injury, including ischemia, brain injury, and more recently, spinal cord injury (SCI). Recent epidemiological trends suggest that SCIs in elderly women are increasing; however, the effects of menopause on estrogen-mediated neuroprotection are poorly understood. The objective of this study was to evaluate the effects of 17beta-estradiol and reproductive aging on motor function, neuronal death, and white matter sparing after SCI of post- and pre-menopausal rats. Two-month-old or 1- year-old female rats were ovariectomized and implanted with a silastic capsule containing 180 microg/mL of 17beta-estradiol or vehicle. Complete crush SCI at T8-9 was performed 1 week later. Additional animals of each age group were left ovary-intact but were spinal cord injured. The Basso, Beattie, Bresnahan (BBB) locomotor test was performed. Spinal cords were collected on post-SCI days 1, 7, and 21, and processed for histological markers. Administration of 17beta-estradiol to ovariectomized rats improved recovery of hind-limb locomotion, increased white matter sparing, and decreased apoptosis in both the post- and pre-menopausal rats. Also, ovary-intact 1-year-old rats did worse than ovary-intact 2-month-old rats, suggesting that endogenous estrogen confers neuroprotection in young rats, which is lost in older animals. Taken together, these data suggest that estrogen is neuroprotective in SCI and that the loss of endogenous estrogen-mediated neuroprotective seen in older rats can be attenuated with exogenous administration of 17beta-estradiol.

Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

STUDY DESIGN

Prospective, cross-sectional study, based on cases of spinal cord injury (SCI).

SETTING

Three outpatient medical departments in Seoul, Korea.

OBJECTIVES

To assess depressive symptoms in patients on clean intermittent catheterization after SCI.

METHODS

In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18-75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI).

RESULTS

For patients and controls, the average total BDI scores were 20.3+/-1.0 and 11.4+/-0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42-10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67-12.81, P=0.003) of depression than those who were able to perform self-catheterization.

CONCLUSIONS

The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.